Global concerns about camel flu: outbreak, etiology, genomic structure, transmission, symptoms, diagnostic tests, prevention, and treatment – correspondence
Authors: Md. Rezaul Islam, Puja S. Dhar, Md. Mominur Rahman
Journal: International Journal of Surgery (2023)

Dear Editor, The Middle East respiratory syndrome (MERS), sometimes referred to as the 'Camel Virus,' has become the source of another WHO notice. A disease with a 35% mortality rate among infected people, which is why many nations have already been put on alert and are starting to urge the best hygienic practices and the already well-known social seclusion1. MERS, sometimes referred to as 'camel flu,' is a respiratory virus that is caused by the Middle East respiratory syndrome coronavirus (MERS-CoV), a zoonotic virus that can transmit from animals to humans, with camels being the main source of transmission. Since its first discovery in Saudi Arabia in 2012, there have been 2600 laboratory-confirmed human cases and nearly 1000 fatalities globally, albeit 80% of MERS-CoV cases affecting humans are restricted to Saudi Arabia2. The 31 118 nt long and 42% guanine–cytosine (GC)-containing consensus MERS-CoV genome was assessed. Eight sick camels from diverse locations in Saudi Arabia were examined to find the isolates that led to its discovery. Eight individual genomes shared 99.9% of their whole sequence. Ten open reading frames (ORFs) are identical between the genomes of the MERS-CoVs that infect humans and camels (ORF1ab, ORF3, spike, ORF5, ORF4a, ORF4b, envelope, membrane, nucleocapsid, and ORF8b). A Basic Local Alignment Search Tool (BLAST) comparison to other strains that were made public by National Center for Biotechnology Information (NCBI) revealed that all of the camel and human MERS-CoV strains shared 99% identity. For the 31 betacoronavirus strains, a comparative investigation of homologous spike protein and gene sequences has been carried out. The spike proteins and genes of the various MERS-CoV strains were remarkably similar (>99.50% and >81%, respectively)3. The results from the camels in Qatar do not demonstrate that the virus spreads from camels to people. Other animals may have been involved, as well as infected humans who may have given it to the camels. Osterholm warns against making the assumption that this just affects camels. 'Other domestic animals are quite likely to be infected as well if camels may be afflicted.' Other species, such as pigeons, chickens, and lambs, were tested as well, virologist Ab Osterhaus, who was engaged in the investigation, confirmed to ScienceInsider, although he declined to discuss preliminary results. According to him, scientists were also attempting to piece together the complete viral sequence discovered in the camel samples. Even if they are successful and the outbreak's connection to camels is established, numerous unanswered concerns remain. For example, it is unclear how many of the recorded cases are associated with transmissions from human to human and how many were from animal to human. Osterholm also emphasizes the possibility of missing numerous minor human instances. According to him, Saudi Arabia has only been testing for the virus in intensive care patients. That is comparable to a drunken person only seeking for their misplaced keys under a streetlight because that is where the light is4. Fever, coughing, and shortness of breath are common indicators of MERS. Despite the fact that pneumonia is relatively common, MERS patients may not always develop it. In addition, reports of digestive problems like diarrhea have been made. Severe illness might result in respiratory failure that requires mechanical ventilation or assistance in an intensive care unit. According to the WHO, those who are older, have weakened immune systems, or suffer from chronic illnesses including diabetes, high blood pressure, cancer, chronic lung disease, kidney disease, or cancer seem to be more prone to developing serious illnesses5. The symptoms can start showing up as soon as 2 days after exposure or as late as 5–6 days later. A severe illness that could cause respiratory failure and mortality will be more likely to affect older persons and people with chronic disorders6. If a doctor suspects you may have MERS, they will first question you about your symptoms, travel history, including whether you have recently visited the Middle East or any other countries where MERS has been confirmed, the recent history of contact with sick people, including those who have been diagnosed with MERS, and recent contact with camels. The doctor will then order a series of tests to diagnose MERS based on your responses, including: (1) blood tests, such as a complete blood count, to look for certain chemicals that MERS makes in your blood and to look for other potential viruses; (2) chest X-ray; and (3) PCR testing, which is done with a nasal or throat swab, mucus sample, stool sample, or some combination of samples and is the only way to formally confirm an active MERS infection7. Avoid close contact with camels, regularly wash your hands, take extra precautions when visiting places where animals are present, avoid close contact with sick people, avoid consumption of raw, undercooked, or unpasteurized camel products, including meat, urine, and milk, and avoiding all contact with camels if you have a health condition that makes you more susceptible to resembling a camel. Although there is no vaccine against MERS, Australian travelers should be current on all advised immunizations prior to departure. Before departing, travelers should speak with their doctor to discuss the dangers and determine whether it is safe to visit the Middle East at this time. Anyone going to impacted areas to work or volunteer in a medical setting should get guidance and make sure they are fully aware of the recommended infection control practices8. A number of MERS-CoV-specific vaccines and treatments are under clinical research, but neither a vaccine nor a specific therapy is currently available. Patients with MERS receive supportive care that is dependent on their clinical state in the absence of MERS-specific medicines. Visitors should take general safety precautions when visiting farms, markets, barns, and other sites where dromedary camels and other animals are present, such as often washing their hands before and after touching animals, and they should stay away from sick animals. Consuming raw or undercooked animal products, such as milk and meat, raises the possibility of getting sick from a number of bacteria that can be harmful to people. Animal products that have been cooked or pasteurized properly are safe to eat, but they must also be handled carefully to prevent contamination of raw foods. After being cooked, pasteurized, or exposed to other heat treatments, camel meat and camel milk are still nutritious foods that can be ingested. People who are more likely to get seriously ill should stay away from dromedary camels, avoid drinking their milk or urine, and steer clear of undercooked meat9. There are no MERS therapies that have been approved. There is not a vaccine for it either. Instead, your doctor will manage and treat your symptoms. You can utilize drugs to get better at home if your symptoms are not severe. They will assist in treating your fever and aches. However, you might need to visit the hospital if your MERS infection is more serious. You might require intravenous fluids, mechanical breathing, or supplementary (additional) oxygen while you are in the hospital10. We have talked here about the following aspects of the camel flu outbreak: etiology, transmission, genomic structure, symptoms, diagnostic tests, prevention, and treatment. Ethical approval Not applicable. Sources of funding Not applicable. Author contribution Md.R.I.: conceptualization, and writing – original draft preparation; P.S.D. and Md.M.R.: writing and editing. All authors have reviewed and approved the final version of the manuscript prior to submission. Conflicts of interest disclosure The authors declare no conflicts of interest, financial or otherwise. Research registration unique identifying number (UIN) Name of the registry: not required. Unique identifying number or registration ID: not required. Hyperlink to your specific registration (must be publicly accessible and will be checked): not required. Guarantor I, Md. Mominur Rahman (corresponding author), take full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. Data availability All data are available within the manuscript.